Provider Demographics
NPI:1518175330
Name:ECCARIUS EYE CLINIC, PC
Entity Type:Organization
Organization Name:ECCARIUS EYE CLINIC, PC
Other - Org Name:ECCARIUS EYE CLINIC OPTICAL SHOP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:ECCARIUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:605-343-4120
Mailing Address - Street 1:631 SAINT ANNE ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-4678
Mailing Address - Country:US
Mailing Address - Phone:605-343-4953
Mailing Address - Fax:605-343-3397
Practice Address - Street 1:631 SAINT ANNE ST
Practice Address - Street 2:SUITE 103
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-4678
Practice Address - Country:US
Practice Address - Phone:605-343-4953
Practice Address - Fax:605-343-3397
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ECCARIUS EYE CLINIC PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-18
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD9281520Medicaid
SD4997507OtherBLUE CROSS AND SHIELD
SD0472960001Medicare NSC